TUMOR BOARD

UNIT 5
PROF.DR.P.SUMATHI M.S., D.G.O.,

DR.B.SIVASUBRAMANIAN M.S., PG
70/M ulcer - right foot 6 months,swelling in both
inguinal regions 4 months.
H/O burns over the same site 6 months back
following which he developed a blister which
ulcerated later on.
No H/O altered sensations
No h/o claudication pain,trauma.
H/O pain during weight bearing
Past H/O
No diabetes/SHT/TB/BA.
 EXAMINATION
• Conscious
• Oriented
• Afebrile
• Not anemic
• No pedal edema
• CVS-s1s2 heard
• RS-NVBS
• P/A-soft,B/L reducible Direct inguinal hernia
present.
• Ulcer over the right foot sole near the calcaneum towards the
lateral border of the foot of size 1 * 1 cm with punched out edges
irregular margins soft tissue as floor and base. Another lesion
nearby the first lesion of size 0.5 mm macular lesion
hyperpigmented with irregular margins.
• No induration.
• Medial-4 cm from medial border
• Lateral- 2 cm beyond the lateral border of sole
• Anterior-10 cm from digital cleft level.
• Posterior-2 cm from heel border

Without any discharge with minimal slough.

No right inguinal lymphadenopathy,no popliteal lymphadenopathy.
No peripheral neurovascular defecit.
3 CM CLEARANCE
CIRCUMFERENTIALLY
Basic blood investigations normal.
Serum LDH-105 U/L.
CECT adomen and pelvis-normal study
except for calcified granuloma 2.6*2.2.
cm in the right lobe of liver
Biopsy from ulcer
Stratified squamous epithelium with infiltrating
neoplasm composed of cells in nodules and
sheets.
Tumor cells are spindle shaped with scant
eosinophilic cytoplasm with hyperchromatic
nucleus with prominent nucleolus and nuclear
inclusions, occassional presence of intracellular
and extracellular melanin is noted.
Suggestive of malignant melanoma.
T4bN0M0-STAGE IIC
 Discussion
1.Should we go for Wide local excision and flap
cover given the clearance to be made being 3
cm circumferentially and also a depth of 3 cm?
Or should we go for BK amputation?
2.Should we do prophylactic inguinal lymphnode
dissection or do sentinel lymphnode biopsy and
decide?
3.Since the patient is having B/L inguinal hernia
can we do Hernioplasty in the same sitting?
THANK YOU